Respiratory System Block

DEPARTEMEN PATOLOGI ANATOMI Fakultas Kedokteran Universitas Sumatera Utara Medan-2011

TUBERCULOSIS

… TUBERCULOSIS

… TUBERCULOSIS

PRIMARY PULMONARY TUBERCULOSIS, Ghon complex

• The gray-white parenchymal focus (under pleura in the lower part of upper lobe)

• Hilar lymph nodes with caseation (on the left)

GHON COMPLEX

HISTOLOGICALLYSites of active involvement are marked by a

characteristic :

That forms both tubercles

&

THE MORPHOLOGIC SPECTRUM OF TUBERCULOSIS

A characteristic tubercle at low magnification :Central caseation surrounded by epithelioid &

multinucleated giant cells.

(D, Courtesy of Dr. Dominick Cavuoti, Department of Pathology, University of Texas Southwestern Medical School, Dallas, TX.)

Central caseation surrounded by epithelioid & multinucleated giant cells.

(D, Courtesy of Dr. Dominick Cavuoti, Department of Pathology, University of Texas Southwestern Medical School, Dallas, TX.)

In immunocompetent individuals, tubercular granulomas might not show central

caseation

(D, Courtesy of Dr. Dominick Cavuoti, Department of Pathology, University of Texas Southwestern Medical School, Dallas, TX.)

In immunosuppressed individuals, tuberculosis may not elicit a granulomatous response

("nonreactive tuberculosis“)

(D, Courtesy of Dr. Dominick Cavuoti, Department of Pathology, University of Texas Southwestern Medical School, Dallas, TX.)

… TUBERCULOSIS

Secondary pulmonary tuberculosis

The upper parts of both lungs are riddled with :•Gray-white areas of caseation & •Multiple areas of softening & cavitation.

Cavitary Tuberculosis• When necrotic tissue is

coughed up cavity

• Typical for large granulomas

• More common in the secondary reactivation tuberculosis - upper lobes.

Tuberculous Granulomas

… TUBERCULOSIS

• The cut surface shows numerous gray-white granulomas

Miliary tuberculosis of the spleen

Lymphadenitis

Adrenal TB - Addison Disease

Testes TB Orchitis

TB Peritonitis + Liver Miliary TB

TB Brain – Caudate

TB Intestine

Prostate TB

Spinal TB - Potts Disease

• Foreign body granuloma• Fat necrosis• Fungal infections• Sarcoidosis• Crohn’s disease

Granuloma / LH giant cell is not pathagnomonic of TB…!

PNEUMONIA

PNEUMONIA

PNEUMONIA

The Anatomic distribution of bronchopneumonia & lobar pneumonia

BRONCHOPNEUMONIA (Pathogenesis)

… Bronchopneumonia (Pathogenesis)

• Infant & old • Weakness patient

– Carcinoma, cardiac failure, chronic kidney failure, traumatic cerebrovascular

• Acute bronchitis• Chronic obstruction respiratory tract, or • Cystic fibrosis & • Post operative

BRONCHOPNEUMONIA

LOBAR PNEUMONIA

PNEUMONIA (STADIUM)

… PNEUMONIA (STADIUM)

… PNEUMONIA (STADIUM)

… PNEUMONIA (STADIUM)

SPECIAL PNEUMONIA

PNEUMONIA NON-INFECTIONASPIRATION

… PNEUMONIA NON INFECTION

LIPID PNEUMONIA

… PNEUMONIA NON INFECTION

• EOSINIPHYLIC PNEUMONIA

OBSTRUCTION LUNG DISEASE

LOCAL OBSTRUCTION LUNGDISEASE

DIFUSE OBSTRUCTION LUNG DISEASE

CHRONIC BRONCHITIS

Severe

• Hypercapnia• Hypoxia & cyanosis (blue bloaters)]

Chronic Bronchitis

NormalCD/AB = 0.4

Reid Index

= Ratio of thickness of mucous gland layer (CD) to the thickness between the epithelium and the cartilage (AB) (normally 0.4).

• The closer to 1 means ↑ thickness & correlated to progression of disease

Chronic Bronchitis

• Clinical course• Bronchi & bronchioles are obstructed by mucus plugs

• bronchiolitis obliterans.

• In long-standing cases,

• squamous metaplasia & dysplasia (precancerous)

• predisposes for squamous cell carcinoma

??

EMPHYSEMA

EMPHYSEMA

A.Diagram of normal structures within the acinus, the fundamental unit of the lung. A terminal bronchiole (not shown) is immediately proximal to the respiratory bronchiole.

B. Centriacinar emphysema with dilation that initially affects the respiratory bronchioles.

C. Panacinar emphysema with initial distention of the peripheral structures (i.e., the alveolus and alveolar duct); the disease later extends to affect the respiratory bronchioles.

ASTHMA

BRONCHUS IRRITABLE (+) BRONCHUS SPASM

MUCOUS (>>) OBSTRUCTION DYSPNOE

TYPE : - ATOPIC - NON ATOPIC - ASPIRINE INDUCED - OCCUPATIONAL - ALLERGIC (ASPERGILLUS)

Bronchial Asthma

NON ATYPIC ASTHMA

T. RESP. INFECTION CHRONIC BRONCHITIS

ALLERGEN TEST (-) LOCAL IRRITATION BRONCHUS

CONSTRICTION

ASPIRINE INDUCED ASTHMA

MECHANISM (?)

+/- PROSTAGLANDINE DECREASE / LEUKORINE INCREASE RESP. TR. IRRITABLE

RHINITIS, NASAL POLYPS,

URTICARIA (+)

OCCUPATIONAL ASTHMA

REACTIVE HYPERSENSIVITY (ALLERGEN)

DYSPNOE COUGH (CHRONIC) ALLERGEN :

- WOOD

- CHEMICAL

- ETC

ASPERGILLUS BRONCHITIS ALLERGY

SPORA ASPERGILLUS FUMIGATUS HYPERSENSITIVITAS REAC. DYSPNOE MUCOUS GLOBULE ASPERGILLUS

HYPAE (+)

BROCHIECTASIS.

ETIO : - BRONCHUS OBSTRUCTION

- INFECTION (SEVERE) - CONGENITAL (<<<)

BRONCHUS & BRONCHIOLUS DILATATION COUGH (CHRONIC), DYSPNOE, SPUTUM (>>>)

+ BLOOD

BRONCHIECTASIS CLINIC :

- LOBUS INFERIOR + INFECTION - CLUBBING FINGER

COMPLICATION PNEUMONIA, EMPIEMA, SEPTICAEMIA, MENINGITIS, ABSCESS METASTASIS

(CEREBRAL), AMYLOID (+)

Bronchiectasis Gross

Distended peripheral bronchi (Due to weakening of wall)

LUNG NEOPLASMA

PRIMARY LUNG CA ANOTHER LUNG NEOPLASMA

- BENIGN

- MALIGNANT SECONDARY LUNG

NEOPLASMA

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